Update of the molecular epidemiology of KPC-2-producing Klebsiella pneumoniae in Brazil: spread of clonal complex 11 (ST11, ST437 and ST340).

Objectives: To perform molecular epidemiology for 113 KPC-producing Klebsiella pneumoniae isolated in 2010 from 12 Brazilian states.
Methods: The resistance profile was determined by disc diffusion and Etest. Genetic polymorphism was analysed by PFGE and multilocus sequence typing. The genetic environment of the bla(KPC) gene was determined by PCR and identification of the carrier plasmid was determined by hybridization.
Results: Most of the isolates were multidrug resistant, with 15% and 49% being resistant to polymyxin and tigecycline, respectively. Twenty-two sequence types (STs) were observed, with ST11, ST437 and ST340 [clonal complex 11 (CC11)] being the most prevalent (75% of isolates) observed in 10 states. bla(KPC-2) was associated with transposon Tn4401 'b' and in 36% this gene was found in IncN plasmids of 40 kb.
Conclusions: In Brazil, the spread of bla(KPC-2) is occurring due to dispersion of Tn4401 'b', carried by IncN plasmids of 40 kb, and mainly the dissemination of CC11, with ST437 and ST11 playing an important role.